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No Good News On Opinions of the Affordable Care Act

The latest Kaiser Family Foundation health reform tracking poll is out, and it's pretty seriously depressing. Essentially, as time passes, people understand less and less about the Affordable Care Act. This is the opposite of what the Obama administration and congressional Democrats want, of course, but it springs directly from the way the bill was designed and its implementation scheduled. Basically, we had this big contentious debate, Democrats won, then ... nothing. Because most of the bill's provisions don't take effect until 2014, most people haven't benefited from it (or aren't aware that they have, in the case of the provisions that have taken effect), and practically the only time they ever hear about it is when Republican politicians say it's destroying America and pledge to repeal it. In their quest for a good CBO score, Democrats sowed the seeds of their own public-opinion problem.

Some highlights from the poll: Barely half of uninsured Americans know that the ACA will provide financial help for those without insurance to buy it, and only 31 percent of them think it'll help their own situation. Only 58 percent of all Americans know about this provision, a number that has declined from 72 percent last December. Only 49 percent know that the ACA expands Medicaid, down from 62 percent last December. Support for the law is down to 39 percent (though as always, some of the opponents are people who think it didn't go far enough).

You might look at this and say, well, once people start reaping the benefits of the ACA in 2014, they'll realize that it really was a terrific thing, and views will change. The problem, as I've argued before, is that the ACA isn't a "program" in the sense that Medicare or Social Security is. It's a complex set of initiatives and regulations. No one will say, "I get my health insurance through the Affordable Care Act." Although you'll be getting your insurance within a regulatory context that the ACA set, or getting it through an insurance exchange that the ACA established, the government's involvement will be almost invisible. You'll still be dealing with private companies to get both your insurance and your care, unless you're on Medicare or Medicaid.

On the bright side, though Republicans can get applause among primary voters by promising to repeal the ACA, they know very well that the act's particular provisions are quite popular. That means that for all the talk, they'll be very wary about repeal, since none of them wants to have to explain why they think insurance companies ought to be able to deny you coverage because of a pre-existing condition or kick you off when you get sick.